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Advance Decisions Policy

It is a general principle of law and medical practice that adults have a right to consent to or refuse treatment. The courts have recognised that adults have the right to say in advance that they want to refuse treatment if they lose capacity in the future, even if this results in their death. A valid and applicable advance decision to refuse treatment has the same force as a contemporaneous decision. This has been a fundamental principle of the common law for many years and is now set out in the Mental Capacity Act 2005, which came into force in 2007 supported by the Code of Practice to the Act. Derbyshire Community Health Services NHS Foundation Trust aims to achieve a more balanced partnership between patients and healthcare professionals and acknowledges that it is the right of every adult patient with capacity to determine whether or not to accept medical treatment. In addition, it is the right of every adult patient to express views about their future care and treatment. The primary responsibility lies with the patient (the maker) to write an Advance Decision to Refuse Treatment (ADRT). The Trust endorses the good practice of staff, set out in national guidance and professional standards to provide information to and general support for patients who wish to write an ADRT. The Trust always encourages patients who wish to discuss their plans for future care and will provide advice to patients and support to advance care planning by helping to coordinate care and communicate plans. In addition, it is supportive of those patients who present with an advance decision and where this is valid and applicable, comply with that specific decision. This policy should be read in conjunction with the Trust’s Consent Policy and aims to raise awareness and give guidance to staff about advance decisions.

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Promotion and Management of Continence for Adult Services Policy (P10)

This policy aims to identify a framework for the standards of care and best practice for bladder, bowel and continence promotion. The range of multidisciplinary professionals involved in continence care is diverse, and it is therefore essential that a continence service delivers integrated working practices across organisational and professional boundaries in order to provide effective care and efficient use of resource. The information detailed within this document will assist healthcare professionals who are undertaking a continence assessment and sets the standards of care for patients who present with a bladder or bowel problem. The continence advisory service aims to provide a quality service to all adults registered with a Derbyshire or Derby City GP. People with continence needs should be seen at the most appropriate time by the most appropriate professional. Excellence in continence care (2018) suggests that the initial assessment is best undertaken by staff trained in continence care within in a community setting, the provision of a high-quality assessment is the foundation of high-quality continence care.

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